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MAII.ING ADDRESS. IF D=r ';T: <br /> COMPANY NAME (DBA) %� �u - 1y1XU,) �J ,a w.J <br /> STREET (�n� ;I,Qdf .�1�( IUtI✓ ��{Ill9� <br /> CITY STATE ZIP 1 <br /> COUNTRY <br /> ((only complm if mt USA) <br /> CONTACT PERSON May/ f e -}T IZ?n PHONE NUMBER(LZZL - 9Z' t- <br /> (Fitt Name) (Lam Name) <br /> III. TYPE OF COMPANY: STANDARD INDUSTRIAL CLASSIFICATION (SIC) CODE: <br /> Use either one or two SIC codes (a four digit number) that best describe your company's products, services, or industrial activity. <br /> Eramoie: 7384 PhotoFnishine lab 3672 Primed circuit boards <br /> First: '5151 Second: <br /> IV. PRIOR PERAUT STATUS: Check yes or no to each question: <br /> YES NO <br /> ❑ U 1. Did you file a PBR Notice of Intent to Operate (DTSC Form 8462) in 1992 for this location? <br /> ❑ 1 2. Do you now have or have you ever held a state or federal hazardous waste facility full permit or interim <br /> status for any of these treatment units? <br /> ❑ 3. Do you now have or have you ever held a state or federal full permit or interim status for any other <br /> hazardous waste activities at this location? <br /> ❑ 4. Have you ever held a variance issued by the Department of Toxic Substances Control for the treatment you <br /> am now notifying for at this location? <br /> LI C] 5. Has this location ever been inspected by the state or any local agency as a aazardot s waste generator? <br /> V. PRIOR ENFORCENIENT HISTORY: Na required from genermarr only notifying as mnditiona/l.v eranpr. <br /> YES NO <br /> ❑ ❑ Within the last three years, has this facility been the subject of any convictions, judgments. settlements, or fina: <br /> orders resulting from an action by any local, state, or federal environmental, hazardous waste, or public health <br /> enforcement agency? <br /> (For the purposes of this form, a notice of violation does not constitute an order and need not be mooned unless <br /> it was not corrected and became a final order.) <br /> ❑ If you answered Yes, check this box and attach a listing of convictions,judgments, settlements, or orders and a cop) <br /> of the cover sheet from each document. (See the Instructions for more information) <br /> DTSC 1772 (1/93) Page <br />